Hospital Pharmacy - September 2017 - 564

723997
research-article2017

HPXXXX10.1177/0018578717723997Hospital PharmacyMcDaniel et al

Article

Doubling Pharmacist Coverage
in the Intensive Care Unit: Impact
on the Pharmacists' Clinical Activities
and Team Members' Satisfaction

Hospital Pharmacy
2017, Vol. 52(8) 564-569
© The Author(s) 2017
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https://doi.org/10.1177/0018578717723997
DOI: 10.1177/0018578717723997
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Joshua McDaniel1,2, Lynn Bass1, Toni Pate1, Michael DeValve3,
and Susan Miller2

Abstract
Background: National professional organizations have recognized pharmacists as essential members of the intensive
care unit (ICU) team. Critical care pharmacists' clinical activities have been categorized as fundamental, desirable, and
optimal, providing a structure for gauging ICU pharmacy services being provided. Objective: To determine the impact
the addition of a second ICU pharmacist covering 30 adult ICU beds at a large regional medical center has on the
complexity of pharmacists' interventions, the types of clinical activities performed by the pharmacists, and the ICU team
members' satisfaction. Methods: A prospective mixed-method descriptive study was conducted. Pharmacists recorded
their interventions and clinical activities performed. A focus group composed of randomly selected ICU team members
was held to qualitatively describe the impact of the additional pharmacist coverage on patient care, team dynamics, and
pharmacy services provided. Results: The baseline period consisted of 33 days, and the intervention period consisted
of 20 days. The average complexity of interventions was 1.72 during the baseline period (mode = 2) versus 1.69 (mode
= 2) during the intervention period. The number of desirable and optimal clinical activities performed daily increased
during the intervention from 8.4 (n = 279) to 16.4 (n = 328) and 2.3 (n = 75) to 8.6 (n = 171) compared with the baseline,
respectively. Focus group members qualitatively described additional pharmacist coverage as beneficial. Conclusion: The
additional critical care pharmacist did not increase pharmacy intervention complexity; however, more interventions were
performed per day. Additional pharmacist coverage increased the daily number of desirable and optimal clinical activities
performed and positively impacted ICU team members' satisfaction.
Keywords
critical care, pharmacy services, intensive care unit, interdisciplinary team, critical care pharmacist

Introduction
Substantial literature exists to support the value of pharmaceutical care provided by critical care pharmacists.1-6
Numerous studies show critical care pharmacists provide
improved clinical outcomes for patients, including decreased
intensive care unit (ICU) length of stay (LOS) and lower
hospital mortality.1,2,4,5 Many studies report the financial
benefits from averted adverse drug events, direct cost savings from reduced laboratory orders, and reduced medication costs related to the interventions made by critical care
pharmacists in the ICU setting.1,2,4,5
In 2000, a task force convened by the American College
of Clinical Pharmacy (ACCP) and Society of Critical Care
Medicine (SCCM) identified and described fundamental,
desirable, and optimal services provided by a critical care
pharmacist.7 This task force's work resulted in a position

paper describing critical care pharmacy services that could
be used to assist in establishing or advancing critical care
pharmacy practices.7
While the ACCP and SCCM position paper provides a
framework for categorizing the activities of a critical care
pharmacist, the literature is less clear on categorizing the
complexity of interventions and recommendations made
by the critical care pharmacist. Although not ICU specific,

1

Cape Fear Valley Health System, Fayetteville, NC, USA
Southern Regional Area Health Education Center, Fayetteville, NC, USA
3
Fayetteville State University, NC, USA
2

Corresponding Author:
Joshua McDaniel, Clinical Pharmacist Specialist, Fayetteville VA Health
Care Center, 7300 South Raeford Road, Fayetteville NC 28304.
Email: mcdaniej@goldmail.etsu.edu
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